Chirurgie de la névralgie pudendale par voie transglutéale

The surgical treatment of pudendal neuralgia is considered when conservative treatments, such as neuropathic pain medication, pudendal nerve infiltration, and physical therapy, fail. The indication for surgery depends on at least one positive result of pudendal block. The trangluteal approach makes it possible to see all the conflicting areas visible at the subpiriform canal, pince ligamentaire — between the sacrotuberal ligament and sacrospinatus ligament — and pudendal canal. It allows the release and transposition of the nerve, restoring its freedom and mobility. This surgical procedure is safe and significantly improves the condition of two-thirds of patients. Age is an important prognostic factor. A randomized study has validated the surgical release of the pudendal nerve by transgluteal approach; it is the only treatment method that has been validated for this disorder. Performing the procedure in knee-chest position and the neurotomy of the obturator internus muscle nerve are two technical advancements that can improve outcome.